The horizon is not so far as we can see, but as far as we can imagine


When I was a young man, I spent a lot of time really sick, and in a pile of pain. It’s not an exaggeration to say I’ve spent days screaming. It’s one of the reasons I have so little tolerance for anyone who excuses torture, or for anyone who stands in the way of effective healthcare, including effective pain medication. This last week, I’ve had an outer ear infection, the first in my life, which, as it turns out, is remarkably painful. Not in the top five of my personal severe pain experiences, but definitely in the top ten.

(This is a re-publish of an article from June 2, 2011. Though I did spend much of the last 24 hours in pain. I am fine now. – Ian)

Of course, the walk-in clinic I went to today had a “even-if-you-are-on-the floor-screaming-covered-with-80-percent-burns-we-will-not-prescribe-so-much-as-a-Tylenol-2” policy. I didn’t even bother to ask. Fortunately, Canada allows some very mild OTC codeine (8 mg, combined with aspirin or acetaminophen, so the addicts can ignore those ingredients, and destroy their livers), so I have a bit of pain medication to take the very worst edge off.

Pain is one of the reasons I believe there is no such thing as a personally-interested, omnipotent benevolent God, because what I know about pain is this: You can experience titanic levels of pain for far longer than you can experience the same level of pleasures. The idea that pain is entirely adaptive is laughable, because pain very quickly gets to the point of incapacitation, and someone who’s incapacitated can’t help themselves.

Anyway, when I was around 25 or so, I wrote down the following aphorisms about pain:

No matter how much pain you are in it can always get worse.

Pain comes in infinite varieties; each type is different.

All other things being equal, mental pain is worse than physical.

The human capacity for pain is infinitely greater than the human capacity for pleasure.

Despite having spent days screaming, I have to say that it’s true that mental pain is worse. At a couple points I was on medicinal steroids, and for me, at least, medicinal steroids are the devil, as they cause brief bouts of insanity. I remember understanding the nature of infinity, in a very Cthuloid fashion (we aren’t just small, we are meaningless) and  knowing that it was literally knowledge I couldn’t live with. Existing with that knowledge was impossible. I would have to kill myself. Strangely enough, I “knew” that my understanding of infinity was caused by the drugs I was on, so I very sincerely promised that if I still remembered my understanding in 12 hours, I’d go get a knife.

Needless to say I don’t still understand infinity, and I avoid medicinal steroids whenever possible.

Then there’s the “pain can always get worse.” This isn’t, I think, actually true. There were a couple points where pain became it’s own anaesthetic. Of course, those levels of pain were at the point where IV morphine was having zero effect, so I guess it’s good.

Pain is also about caring. If you don’t care, pain doesn’t bother you. This is the pain/suffering divide, where you see folks hanging from hooks during religious ceremonies having a great old time. Wheeee! Narcotic pain meds work a bit like this.

Roughly narcotics work at three levels. At the first level you just don’t feel the pain. Maybe a bit of pressure or the occasional ticklishness, but no pain. At the next level, you’re in pain, but you don’t care. The level after that, you’re saying, “You sure you gave me morphine!?”

My most memorable occasion of “in pain but don’t care” was when I started getting muscle spasms. I had a staph infection in my sacroiliac joint (the hospital did not know this yet) and every time my muscles would spasm it’d hit the joint, and I’d scream. The spasms were maybe 5 minutes apart, so objectively, most of the time, I wasn’t in much pain.

The problem, of course, is that I spent the five minutes between spasms worrying about the next spasm, which was totally wrecking me. At the time, my father was visiting me, and watching me coming apart was wrecking him, too. I’d been in the hospital long enough that my stiff upper lip was looking pretty quivery. So he ran around trying to find someone to give me a shot of morphine or demerol. Nurses aren’t supposed to do that without a doctor’s order, and no doctors were available (strangely enough, in hospital wards, doctors are often very hard to find). Eventually he talked a nurse into doing it (and I am grateful to her to this day, since I know she had to justify it later) and I got the shot.

Didn’t make any difference to the actual pain. Every five minutes, bang, the muscle would spasm and I’d scream. But in the time between, I didn’t worry about the pain that was coming up; instead, I was chatting and joking with my dad. Pain and suffering, not the same thing, and I can say that my Dad was suffering a lot less too.

Infinite varieties of pain: Yup. The pain of muscle spasms on a joint inflated with infected fluid is entirely different from the pain of your own body eating the large intestine from the inside out, which is entirely different from the feeling of the small intestine being infected and swelling up so that every time you breath it hurts and you get a wave of nausea.

Oh, and nausea? Worse than pain, in general. Short of knocking you out, there are no good cures for nausea. There came a point in that hospital (and I was there three months) at which my liver decided that everything was an evil foreign object.  Everything. So every four hours, when they’d give me my antibiotics, about ten minutes later, I’d get to dry heave for five to ten minutes. Every four hours, for a couple weeks. Fun.

But I can’t really write this essay without coming to the real problem with pain management. You see, I went in with ulcerative colitis, a disease where your immune system decides that the large intestine is the enemy and needs to be destroyed with extreme prejudice. This involves a lot of bloody diarrhea and a lot of pain–but on the plus side, makes you look positively tuburcular. First time in my life, women were flocking around me. Too bad agony makes one uninterested.

So anyway, I went in and I kept getting worse. A week into my stay, my Gastro (Dr. Kempston) went on holiday. A week after that, I wouldn’t let the nurses so much as touch me. This caused one of the nurses to think, “This may be bad,” and she called in the doctors around midnight on Sunday. They cut me open and discovered out I had late stage appendicitis (as in a couple days from bursting), as well as ulcerative colitis.  So they took that out, along with my large intestine.

Leaving aside certain logistical issues, this is all good. My large intestine hadn’t been doing much for me that didn’t involve, oh, agony, for a couple years. I wound up back in a ward, and my recovery was on.

But there were a couple complicating factors: (1) During those two weeks, I got an infected IV site; (2) I’d been on hard-core immune suppressants for about a month, so it’s safe to say that I didn’t have an immune system. Plus, I’ve had this pain in my sacreal illeac joint (it’s in the lower back). Apparently that’s kind of normal, but what’s wasn’t normal is that the pain I was getting from it was absolutely crippling.  As in, “I can’t even push myself up in bed” crippling, as in, “Every time I am moved, I scream, a lot.” Crippling.

The surgeon then decided, in his infinite wisdom, that because he’d never heard of such a thing in all his years, that I must have been lying in order to get pain meds.

My back doctor didn’t agree. I had no family doctor. What ended up happening was that, every night around 8pm, the surgeon would swing by and say, “You’re a malingering little shit who should be outside running around,” and took me off morphine and onto some oral codeine. Around 8am in the morning, my back doctor would swing by and say, “Now, I don’t know what’s wrong with you, but I’m pretty sure you’re not faking, so I’ll put you back on.” Which meant that I spent half the day without pain meds, and the other half of the day dreading being cut off.

Fun.  Fun.  Fun.

This went on for some time (I’m a bit hazy, but I think it was a little over a week). I was nauseous, in pain, losing weight and muscle tone, and they couldn’t figure out what was wrong. The surgeon kept saying, “That’s because nothing’s wrong. He’s a little drug addict who is faking it! Hell, we should kick him out the door!” The nurses on the ward were divided into two groups, depending on whether they believed me and the back doctor, or if they believed the surgeon (who is apparently a great surgeon who has invented procedures!).

Finally, Dr. Kempston walked in, just swinging by, completely unaware of what was going on. He asked me how I was doing. It still embarasses me to this day, but I broke down. Much weeping ensued, along with the relating story.

Dr. Kempston went to the nurse’s station, and wrote in my file, “I will be acting as Ian’s family doctor. If his pain meds are changed, any time of day or night, I am to be called, and I will change them back.”

You could hear the gauntlet falling all the way down  in the basement. Because if Kempston were wrong, if I was playing him, if I was just trying to get morphine, well, he was about to lose a ton of face. This was what the back doctor wasn’t willing to do, take on the famous surgeon, publicly.

I’d die for Kempston. I mean that totally seriously. If somebody was about to shoot the man, I’d step in front of the bullet without any hesitation and count my life well spent. Hell, I’d be grateful for the opportunity.

Anyway, they figured out what was wrong: a staph infection in my sacroiliac joint. That didn’t bring an end to the surgeon’s suspicions, so later we had a case where every time I breathed in, I felt pain and nausea on my left side. Kempston kicked the pain meds back up. Everyone on the floor knew that if they didn’t find what it was, Kempston would be in a world of hurt.

A couple days later, the test results came in. I had an infection right where it would have to be to cause the symptoms I described. The surgeon crawled in, said some weak stuff about me getting some more surgery in a year, and I didn’t see him again, except in passing.

I spent three months in that hospital.  At one point, I was using a walker (my father and I had lots to joke about when he started suffering from the effects of old age). When I left the hospital, I was about 90lbs. I had a huge bushy beard.  I looked like Jesus come in from the desert. I took myself to a hotel, of course they are freaked out, and I had to put down a $1K depsosit on $50 room, and room service demanded cash up front. (That ended the second my father rolled back into town. The staff then tiptoed around me for the next two days, scared not that I was made of glass, but that they were.) It took me years to recover, though, really, I never have. The easy good health and athleticism I had before is gone and gone forever.

But what I remember is not just that surgeon denying me pain meds due to paranoia and megalomania (he is a great surgeon, so I should have been cured and out of the hospital already and my not being so was an insult to him), and all the other people who didn’t stand up to him, who didn’t stop him, but the one man who did.

And so I’ve always known, since then, that some good people exist. There aren’t  very many of them, most people are chickenshit–too weak to be good or even truly bad, but they do exist. And I know the price that one good man paid; I heard him talk about his daughter, who he hardly ever saw, because he put his patients first, and I saw the regret he had.  And that he understood that when someone was screaming in pain, crying brokenheartedly, or puking up blood, you know what? They come first. And no, you can’t just assume someone else will do it if you won’t, because most people are weak, and most people won’t do it, when push comes to shove.

So when I think about pain, I think about Kempston. I don’t know if he’s the greatest man I ever met, probably not, but I am more grateful to him than anyone else who has ever come into my life.

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  1. Celsius 233

    And so I’ve always known, since then, that some good people exist. There aren’t very many of them, most people are chickenshit, too weak to be good or even truly bad, but they do exist.
    That pretty much echoes my experience. Cheers

  2. Compound F

    Mmm. That hit the spot. I didn’t realize I was famished until after I finished.

    OT, the steroid-induced psychosis is interesting. I assume it was a glucocorticoid, and either they had you jacked to the roof, or you are on the sensitive side of the distribution with respect to its psychoactive properties. It’s become ever more clear in recent years the adrenal steroids have huge effects on brain transmitters, e.g., dopamine (whee!) and neuromodulators, e.g., CRF (fear and dread). They affect so many physiological systems that one can never tell whether it will be a good, bad, or indifferent or even noticeable trip. When Hench (& Kendall) gave his Nobel speech for their work on anti-inflammatory effects of steroids, he astutely noted diverse psychological effects, as well, which no one picked up on until much later. Most rats will self-administer steroids like a pleasurable drug of abuse, but if administered under negative or adverse contexts they seem to heighten the perceived adversity. Their powerful effects on memory systems and neuronal architecture are now well established. Elevated stress hormones are root contributors to PTSD ( a kind of persistent memory of how shitty the world is), among many, many other things.

  3. Morocco Bama

    All loggers, logging companies and developers should be required to consume Ayahuasca on a daily basis. They’d never clear another tree or shrub again. Maybe all of us should be required. We’d be a different species, that’s for sure. There’s a reason Cannabis and Ayahuasca are illegal….well, many reasons, but the over-arching reason is that its decentralized use undermines the social order…..and we can’t have that….the social order is imperative to the Plutocrats exalted status within it. Those vested interests must be maintained and preserved come hook or crook.

  4. someofparts

    So what is your normal health for you these days?

  5. Ian Welsh

    Oh, they had me jacked through the roof, no question.

    someofparts: actually, my normal health isn’t /that/ bad, but certainly, I’ll never do regular manual labor again.

  6. zot23

    Thanks for sharing this Ian, that sounds like a very rough go. I’ve never had an extended or debilitating hospital stay, but have been close to those that weren’t so lucky. Basic human compassion is basic compassion, funny how with all the technology in the world that never changes.

    Hope your infection clears up and is gone for good. Those buggers can reinfect like mad.

  7. guest

    Harrowing. Can’t say I’ve had anything like that level of pain (worst might have been an inner ear infection that lasted 2 weeks of lying on the floor before my folks took me to the doctor just as it started improving), but I have to agree that nausea may be worse than pain. When I was a kid getting ready to throw up, I used to wish someone would kill me so as not to have to endure another moment of nausea. But I’ve met people who don’t mind it at all and one girl who said throwing up makes her laugh.

  8. alyosha

    Great essay. And I enjoyed listening to you and Stirling on the podcast.

  9. jarret

    Ian: yow. my partner is a 9/11 fireman who has unknown massive head pain problems (they’re called cluster headaches, a deceptively mild name). when we have had problems getting doctors to do their *$(*&$ jobs, we have learned to call the hospital administrator. we were also accused of being drug addicts by some insensitive egocentric bastard and calling in the administrator got resolution pdq. good luck.

  10. peter cowan

    damn. it says a lot that i’ve been reading your writing for almost 10 years now and i’ve never seen you mention any of this any level of detail. thanks for writing this, it was absolutely absorbing. i’m truly sorry for your suffering.

    i think maybe this goes along way towards explaining your disposition… now, just gotta figure out what’s up with stirling newberry! 😉

  11. someofparts

    Well, I hope normal health these days is good enough for you to have the ordinary joys of mobility and activity.

  12. Chapbook

    Ian, your experience rings so true. Too many Frank Burns-types out there.

    My SO had kidney stones removed through surgery several years ago. The excruciating pain was not decreasing after a few days, but the surgeon suggested SO needed to stiffen his upper lip. We went out to a friend’s wedding in St. Louis, and SO continued to suffer more and more. We returned to Toronto early, and an ER visit revealed that the surgeon had left in at least one stone, which was trying unsuccessfully to move into the kidney stent. Hence, the agony. We will never go back to that East Side surgeon again.

  13. Z


    I wouldn’t be embarrassed about breaking down to Dr. Kempston. You went through a hell of a lot physically, psychologically, and emotionally. Being bedridden and damn near helpless, caught between a well-respected surgeon’s ego and you’re very real pain while being accused of being deceitful is a hell of a lot to take … especially when you are not in any shape to take it.

    If the self-absorbed surgeon with the big ego got called in from vacation to operate on you, that might have also contributed to his resentment of you.


  14. Lisa Simeone

    Horrifying. I’m so sorry.

    It’s true that for too many people, pain — of any kind — is an abstract concept. Speaking of whom and which:

    When will this sociopathic criminal get his due?

  15. GA

    I have ulcerative colitis. What keeps it in check is smoking. (Added benefits: reduced risk of Alzheimer’s, Parkinson’s, and tuberculosis.) Those who said it would kill me have been wrong so far (I’m 63). I’m terrified that smoking will be banned altogether.

    I get my teeth cleaned under nitrous oxide (I’m sensitive around the gum line). The occasional pain is bearable; not so much the anticipation of pain.

  16. Kyle Michel Sullivan

    You’re a strong man, Ian…a lot stronger than me. You’ve been to hell and discovered the devils outweigh the angels tenfold…and still lived to tell about it. That is power and truth. I wish you nothing but well from this day forward.

  17. jcapan

    Sadly, this is also true:

    “The human capacity for [inflicting] pain is infinitely greater than the human capacity for [giving] pleasure.”

  18. Jay

    Great essay. I can relate to a lot of it. Post brain surgery I had my own bout with steroidal psychosis. I was charging around my parents apartment, walking in circles for hours trying to calm myself down – I was convinced my (stable) brain tumor was exploding and I would be dead within hours. I was in sheer panic.

    Your distinctions between mental and physical pain were different for me. I remember at a certain point not being able to tell the difference between the two. They were so intertwined I really couldn’t tell sometimes if I was in physical pain or just completely mentally anguished. Either way dilaudid (morphine x8) was a great comfort to me. Some hospitals were very liberal handing it out and I’m very grateful.

    Great post.

  19. Ian Welsh

    GA. I’m an asthmatic, so smoking wasn’t possible.

    I am told by others, that for some people Traditional Chinese Medicine (TCM) works quite well. Of course, now, I have only a very little bit of Ulcerative Colitis. No large intestine, but no UC.

    Jay: yes, for people who really are in pain, opiates make a huge difference and not being liberal with them is monstrous. Or as Kempston said at the time “take what you need, and if you do get addicted, we’ll worry about that/after/ you’re better.)

  20. Cathie from Canada

    Very moving story. You learned very early — too early, really — how vulnerable the human body is. Its something some people don’t learn until their 70s.
    After my own hospital experience — badly broken leg, 18 month recovery, five or six surgeries — I was convinced that all medical personnel should go through some unpleasant experiences as part of their training — like a spinal tap, two weeks with their arm in a cast, a barium series — so they would gain a little insight about what they are asking their patients to endure. Some surgeons, in particular, seem to feel insulted when a patient isn’t recovering on schedule.
    Good luck recovering from the ear infection, too.

  21. Oniboshi


    I remember understanding the nature of infinity, in a very Cthuloid fashion (we aren’t just small, we are meaningless) and knowing that it was literally knowledge I couldn’t live with. Existing with that knowledge was impossible. I would have to kill myself.

    Compound F:

    Mmm. That hit the spot. I didn’t realize I was famished until after I finished.

    I always did like fairy cake.

  22. Lynn Barnett

    Thank you for telling your story. I am a doctor. Every time I read about how doctors are overpaid, interested only in money, don’t care about patients they treat, etc., I feel like defending some of the members of my profession. I have been blessed to know my own Dr. Kempstons. Some of them were teachers, supervisors, mentors and colleagues. I can probably count them on one, no almost two, of my hands. But they change lives. I have never forgotten them. I will spend my career trying to follow in their footsteps.

  23. el

    I remember understanding the nature of infinity, in a very Cthuloid fashion (we aren’t just small, we are meaningless) and knowing that it was literally knowledge I couldn’t live with. Existing with that knowledge was impossible. I would have to kill myself.

    Don’t know if it’s connected, but it’s like the secular version of ‘No man can see God and live’, isn’t it? Only then one would understand not only infinity, but many other concepts too. Too big for human psychique.

  24. Ian Welsh

    In retrospect it’s kind of funny, actually, and I laugh now when I tell the infinity party of the story. But it sure wasn’t fun when it was actually happening.

  25. TummyAche

    Oh Ian!
    I have been there. Mostly misdiagnosed, or as in the case of today, not diagnosed at all and put through round after round of the same (cheap) testing for the current ‘in-vogue’ disease dujour… and they find nothing. No one will order a Pet-scan because I have always been (you guessed it) under-insured!
    But since my son has the same pain and problems, eh? (he’s 45 now) then there must be something amiss. And bravo for calling ‘chickenshit’ by it’s proper name… most people are, most doctors I’ve met, poor at best – and the good ones I’ve had (who have saved my life three times so far) – I also, would step in front of a train for. I do the next best thing, frequently, writing them up on various “ratings” sites… trying to edit my comments down for today’s 5 second “twit”! while telling others that they should cancel other appointments and go see Dr. so and so. I send you my best and this is a great essay. Just great. I would have sat by your bedside and howled with you. El

  26. Charles

    Sometimes you read something unpleasant that makes you feel grateful for your current life situation. This post did that for me. Thanks for writing it, I’m sure it wasn’t especially enjoyable to recall this experience but it helped me to forget about my bullshit financial issues for a few minutes and remember that my family is healthy and that’s the most important thing really.

  27. Steeleweed

    I’ve been lucky in that I’ve always been pretty free of pain, even when I’ve broken bones or otherwise injured myself. My wife, on the other hand has been in chronic pain since a Mercedes ran into her on a snowy night outside Boston. Many months in various hospitals, many surgeries, aggravating or perhaps causing arthritis. Two hips, one knee and a shoulder replaced (so far); cervical stenosis; scoliosis; sciatica so bad she can’t walk more than 40 yards without having to sit. She has not had a pain-free day since December 1978.

    Needless to say, she’s had a lot of experience with both pain and pain-management MDs. Unfortunately, chronic pain is commonly under-diagnosed and misunderstood, and too many so-called ‘pain management’ specialists are incompetent – doing it as a ‘side business’ of anesthesiology. I’ve had to ban two ‘pain management’ MDs from being involved with her post-surgical care, because they refused to medicate sufficiently.

    She had both hips replaced and did rehab at Burke in White Plains, NY. The rehab there is 1st class but the MD assigned to each patient is random. The first time she was lucky; the 2nd time not so lucky. I ‘suggested’ they give her Oxycontin 30mgx2 and 10mgx3 (for breakthrough pain) for 3 days, then reduce it to 20mg & 10mg for two more days, then 10mg & 5mg. The MD prescribed 10mgx2 & 5mgx2 and she was screaming enough to scare hell out of the staff. They immediately over-dosed her at 60mg and damn near killed her in the process. Her BP fell thru the floor and it was a very close-run thing whether she would survive. (The upside of the near-death overdose was that she used to have hypertension. The screw-up seems to have reset the blood pressure ‘thermostat’ and her BP has been about 120/70 ever since).

    When the dust had settled, I demanded a different MD and they gave the meds as I had suggested. I told the staff at the time, “There are two sides to any medical situation: the caregivers, facilities, equipment, drugs, training, knowledge & the patient. You know far more than I do about medicine, drugs, & treatment, but I KNOW MY WIFE better than any of you EVER will. Listen for a change and maybe you’ll understand the 2nd half of the equation”.

    For one thing, chronic pain makes the cells more sensitive: there’s an enzyme which rises and falls when cells are traumatized and when it’s high, pain transmissions occur. In chronic pain, the level no longer drops down to ‘low’ (normal) state, so discomfort becomes pain; pain becomes severe; severe pain becomes utter agony; agony becomes screaming, floor-pounding and heart attack risk. More aggressive medicating is required for chronic pain. Good pain specialists understand this but too many are like your surgeon – convinced the patients are faking it.

    To make things worse, the governments are getting paranoid about misuse of opiates. Wife”s been on morphine pumps post-surgery, oxycontin (turns out she’s genetically not able to maximize the benefit of this drug), then morphine, now fentanyl patches and dilaudid. She finally found an MD who does only pain management and understands her condition. And he keeps a strict watch and control, to make the ‘authorities’ happy. The pain is kept at tolerable levels but it still sharply limits her mobility – which is particularly tough mentally & emotionally because she used to be as fine a dancer and anyone might wish to see. Irony: Her pain management MD was a professional dancer who got into medicine when orthopedic pain sidetracked that career.

    Re steroids: My wife once developed Temporal Arteritis and was given IV Prednisone for a day, then put on 80mg a day and went into full-blown Prednisone Psychosis. Her regular MD immediately cut it to 40mg, then 20mg, then 10mg. It took 2+ years to finally taper her completely off the drug. Steroids are not addictive per se but they shut down the body’s production of adrenaline and it’s a delicate balancing act to get things back to normal. (I recently had a COPD flare-up and was on IV steroid for only a few days and it took 6-8 weeks to get back to normal. I felt like my body had downshifted into 2nd gear).

  28. Ghostwheel

    Ian, I can second much of what you say here. I’ve had two family members who have had to deal with chronic pain, as well as medical incompetence, insensitivity and malpractice.

    Yes, you often have to fight to see your family members get the help they need. People with severe physical pain are among the most helpless members of our society, and to have self-righteous medical practitioners assume they are addicts is infuriating and humiliating.

    You have to keep looking until you find physicians who aren’t afraid to help. They’re out there.

  29. dfs

    Your description of high-dose steroids is apt. I took a lot of prednisone for a long time for roughly the same reasons (just a milder case of UC). It’s strange to look back on those days — long stretches of them are completely lost to me, impossible to remember, and regarding others I can clearly recall that I was crazy as a shithouse rat.

  30. subgenius

    @ cluster headaches..

    Try finding a good acupuncturist – I have had success treating cluster and migraine headaches.

    Re. Ulcerative colitis – I have strong suspicions that industrial meat production (steroids and antibiotics) and industrial wheat production (monocultured, so little genetic variation; pesticides – which are trapped in the kernel; and the recent inclusion (historically) as a contant dietary component) play a prime role in the growing incidence.

  31. Ian Welsh

    Ulcerative colitis is treated well by TCM, actually. But I didn’t know that at the time.

  32. markfromireland

    @ Steeleweed October 3, 2015

    For one thing, chronic pain makes the cells more sensitive: there’s an enzyme which rises and falls when cells are traumatized and when it’s high, pain transmissions occur. In chronic pain, the level no longer drops down to ‘low’ (normal) state, so discomfort becomes pain; pain becomes severe; severe pain becomes utter agony; agony becomes screaming, floor-pounding and heart attack risk. More aggressive medicating is required for chronic pain. Good pain specialists understand this but too many are like your surgeon – convinced the patients are faking it.

    I’m fortunate that there’s a good multi disciplinary pain clinic in my local hospital. Getting referred to them was difficult but once there my life improved out all recognition. Your point about sensitisation is very important and by no means as well-known as it should be. There’s also another side to this sensitisation which is that one may be able to cope with a certain level of pain (by whatever means) but any extra pain – a headache, a strained muscle, a tooth or ear ache, a stubbed toe, anything no matter how “mild”* in an of itself is enough to drag you screaming over the line of what you can cope with.


    * When I say “mild” here I mean something that you probably wouldn’t even take two paracetemol for under ordinary circumstances.

  33. Ian Welsh

    One thing I am fortunate in is that I don’t have chronic pain. Intermittent acute episodes, some of which have been terrible and lasted months, but not “on and on”.

    One does become acclimated after a time, but no matter how acclimated, at least in my experience, there’s a level at which *boom* “fuck, this hurts!” occurs. For me, at least, the worst is going to sleep–pain I can handle during the day with various concentration/attention tricks become unbearable when I’m trying to sleep, and it is then that I pretty much have to have some sort of pain killer.

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